Sunday, March 21, 2010

Vague Writing Creates Opportunities for the Powers-that-Be: Naming Names re: NC Mental Health Reform Mess

Let’s Have the Specifics about Current Mental Health Treatment in NC

By Marsha V. Hammond, PhD

In an editorial by Community Mental Health co-director, Barbara B. Smith, about the need for efficient treatment of schizophrenia, a SPMI (Severe Persistent Mental Illness), she outlined some suggestions to improve the situation. She alluded to the following well-known problems: necessary completion of a ’13 page form’ prior to receiving treatment; adequately funding public mental health; and, the maintenance of long-term, flexible, community based services. So, let’s review and name names behind her potent and admirable suggestions.

The ’13 page form’ is what NC DHHS and as their agent, the LME’s (Local Management Entity; in western NC there are two, namely, Western Highlands Network and Smoky Mountain Center) demands. This is why I do not work with the LME’s but function in the shadows of private practice, billing directly to Medicare/ Medicaid. Until those systems figure out that creating paperwork is nothing but a barrier to care, then I will continue to do the same. This means that people with SPMI have one less doctoral level clinical psychologist to interface with when they walk into the door while having a psychotic episode.

Mental health care company after company is folding in western NC due to the complete dissolution of Community Support Services (CSS) which was the lynchpin piece of NC Mental Health Reform, which began first in western NC (funny how the changes start out so far from Raleigh). CSS is the long-term, flexible, community based services of which Ms. Smith appears to be speaking and as of January 1, 2010, it is kaput due to years of flogging by Governor Easley, poor organization by former NC DHHS Secretary Carmen Hooker Odom, and the acceleration of the need for services as jobs tank. The NC State Legislature put NC Mental Health Reform into play only to remove it 8 years later. We are now back to the place wherein the clinical psychologist must utilize therapy time----billed to NC Medicaid----in order to do basic social work jobs like get someone to a physician’s appointment or find some food for the table. There is no point in therapy when the patient is starving.

An important matter which Ms. Smith does not speak to is just how BCBSNC has been able----as supported by the NC State Legislature----to opt out of mental health reform. This company is the largest private insurer in NC but is kowtowed to by the state legislature that, don’t ya know, has a ‘special liason committee’ to oversee BCBSNC. When mental health parity was passed about a year and a half ago in NC, specifically House Bill 973, BCBSNC got special concessions from the state which limited mental health care. Even more maddening than this, is that the NC Psychological Association sat on its hands as BCBSNC worked the state legislature. And the icing on the cake was then to be elected Beverly Perdue’s contention that more ‘case management’ services were needed, rather than hands on CSS. Case management is paperwork and that’s it. Citizens with SPMI have gone from an abundance of CSS hours to less than one hour/ week and the elephant in the room is the fact that private insurance companies continue to get special amenities which allows them to suck in 50 cents on the dollar as related to administrative costs. As related to the health care brouhaha, there is no way that a public option could do worse.

Reference (Ms. Smith's Opinion piece:


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